Provider Demographics
NPI:1184798142
Name:CONNER, JOHN M (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:CONNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 STATE ST
Mailing Address - Street 2:SUITE 424
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-6808
Mailing Address - Country:US
Mailing Address - Phone:812-944-0765
Mailing Address - Fax:812-948-1489
Practice Address - Street 1:1919 STATE ST
Practice Address - Street 2:#424
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6808
Practice Address - Country:US
Practice Address - Phone:812-944-0765
Practice Address - Fax:812-948-1489
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29759207X00000X
IN01046366A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64881709Medicaid
IN200151200Medicaid
F72326Medicare UPIN
KY64881709Medicaid
IN200151200Medicaid